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Lictag
Lictag
Lictag
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 1
SOURCE PARASITE
Pork Trichenella spiralis & Taenia solium
Malarial parasites
Beef Taenia saginata Filarial parasites
Trypanosomes (Trypanosoma
Blood
Diphyllobothrium latum & Capillaria brucei gambiense, trypanosome
Fish cruzi)
philippinensis
Tissue Nematodes
Vegetation Fasciola hepatica Liver and Lung trematodes
(Fasciola hepatica, Clonorchis
Crabs Paragonimus westermani sinensis, Paragonimus spp.)
Snail Echinostoma ilocanum Intestinal Trematodes
(fasciolopsis buski, Heterophyes
Stool
heterophyes)
3. Vectors
- Invertebrates, arthropods / mollusks Blood trematodes
(Schistosoma mansoni,
- “vector-borne parasites” Schistosoma haematobium,
Biological vectors – required in the life cycle Schistosoma japonicum)
Mechanical vectors – for transport. Referred to as Intestinal
“ harborage vector” (cryptosporidium spp. ,
4. Animals Sputum Cyclospora cayetenensis)
- Either be domestic/ wild Liver and lung trematodes
- Zoonosis ( infection acquired from an animal) (Paragonimus spp. )
Tissue Protozoa
5. Other person – referred to as “”contact-borne parasites” (Toxoplasma gondii)
Free living amoebae
(Naegleriafloweri, Acanthamoeba
6. Oneself CSF spp. )
- Infection is referred to as “autoinfection”
Trypanosomes ( Trypanosoma
cruzi, Trypanosoma brucei
Anus ---- fingers ---- mouth gambiense)
Ex. Enterobius vermicularis
Blood trematodes ( Schistosoma
Ex. Strongloides stercolaris mansori, Schistosoma
Urine Haematobium)
7. Fomites Urogenital Flagellates
( Trichomonas vaginalis)
- Inanimate objects w/c becomes contaminated and causes
infection
Pathophysiology of Parasitic infection:
Portals of Entry: Parasite factor – leads to disease / non-infection. Depends on the
Any channel or the way through which the parasites gain access to the pathogenicity of the parasite
body of the host. Host – depends on the host defense mechanism
Mouth (ingestion of infective stage) a. Factors of pathogenicity:
Skin(direct penetration of larva stage) 1. Parasite burden - Refers to the number of parasites in the host
Respiratory tract, GUT, conjunctiva, other mucusmembrane ( > in # of parasite = > damage in the host)
2. Tissue tropism
Portals of Exit: - Affinity of the parasite to a particular tissue or cell in the
Channel through which parasites leave the body of the host. Usually the host
same as the portal of entry. - Damage depends on the locality of parasite
3. Pathogenesis
Nb. Importance: gives as the idea what specimen to collect from the - Mechanisms by which damage or injury is produced
specified site. i. Spoliative action
- Competing with the host’s essential nutrients --- depletion
in the host
- ex. Dipyllobothrium latum – feeds on vit. B12 leading to vit.
B12 deficiency (megaloblastic anemia)
ii. Trauma/ physical damage
- Attachment of parasite, migration of parasites in the body
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- Ex. Hookworm- has bucal cavity & teeth/ cutting plates, used
for attachment to host tissues. found in the intestinal mucous, Nonspecific Defenses Specific Defenses
causes ulceration to the intestinal worm
Malaria parasites – inhabit RBC Offer protection to any foreign Offers protection to a
Ascaris – largest parasite of man , forms “ascaris bolus” agent; present at birth already particular foreign agent only
(entangled ascaris blocks the GIT)
iii. Lytic Necrosis “Natural / native “ “Acquired” by contact with Ag
- Brought upon by enzyme system of parasite; secrete enzymes
that have enzymatic activity that can breakdown the tissue Eosinophilia :
Ex. Entamoeba histolytica – cysteine proteinase - Increased in eosinophil #
iv. Toxic and allergic manifestations/ phenomenon - Acts in parasitic infection, > in asthma/ allergic reactions
- Metabolic products of parasites which are toxic to the host Eosinophils
considered “foreign” ---- allergy - Granulocyte; does not engulf, undergoes degranulation
v. Stimulation of the host tissue reaction - Releases the granules in the env’t which contains lytic factors
- Undergo: causing holes in the integument of the parasite--- killing of
Phagocytosis parasite (extracellular killing)
Inflammation - Inflammatory factors produces granuloma to protect the host
Granuloma – single cell surrounded by the parasite;
called tubercle; offers production to the host; protective 2 types of immune response:
mechanism 1. Humoral immune response
vi. Secondary invasion - Mediated by B- lymphocytes , differentiated into a) memory
- Parasites produce pathways for other pathogens to enter the B-cells---anamnestic response; b) plasma cells – actively
host producing cells
2. Cellular immune response
Modes Of Transmission: - Mediated by the T-lymphocytes
1. Contact Transmission
- Known as CMI
- Requires the coming together of the host and the infection
and the next generation host - Requires the activation of macrophages—APC
(antigen presenting cells)
Via direct contact transmission
- Contact of portal of entry of the next host and portal of exit Mechanism of Elimination of Antigen for Humoral IR
of the original host 1. Agglutination
- Through sexual activities – horizontal transmission - Reaction between Ab and a particulate Ag
- Through vertical transmission (trans placental, mother to - Agglutinin (Ab) ; Agglutinogen (Ag)
baby after & during birth, trans mammary) Precipitation
Via indirect contact transmission - Reaction between Ab and a soluble Ag
- Fomites are transmitted to host to host via intermediate - Precipitin (Ab) ; Precipitinogen (Ag)
objects. 2. Neutralization of toxins / or toxic neutralization
2. Air-borne transmission - Ab are referred to as “antitoxin” (neutralizes toxins, before
- Inhalation of parasites they can attach to tissues and infect the host.
(ex. Enterobius vermicularis – infective about 4-6 h) 3. Steric hindrance
3. Common vehicle transmission 4. Opsonization
- Refers to non-living reservoir - Coating of microorganism
- Inanimate reservoir - Impt. For encapsulated bacteria / organism
Ex. Through water, soil etc. - “Opsonins” – Antibodies (process of coating microorganisms
4. Vector- borne transmission by the Ab and recognized by phagocytes to be readily
- Transmission through the aid of vectors phagocytized)
5. Activation of compliment pathway
Host Defenses Complement: activatd when/ by Ag- Ab complex
3 lines of host defenses: C5b6789
1st line: includes skin, mucous membranes; protection at the – impt for killing of Ag; referred to as MAC (membrane attact
portal of entry complex); a cytolysin
2nd line : accumulation of phagocyte, cellular and chemical - Inserts itself to cell membrane of the target cell, producing
response pores transmembrane channels results to leakage/ spillage of
3rd line : immune responses ; Ab - Ag reactions cell content (cellular killing)
(Ab production – shows specificity ) 6. ADCC
“ antibody dependent cellular cytotoxicity”
- Ab form a bridge / acts as a bringing mechanism between Ag
and effector cell
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NB. There is acquired immunity for parasitic infection (acquired Saline wet mount Iodine wet mount
immunity is at low levels)
- Not long lasting ( immunity confers resistance in the host, Initial microscopic examination Mainly o stain glycogen and the
only when the parasite is within the host) of fecal specimen nuclei of the cysts
- Acquired immunity only confers resistance from hyper Employed to demonstrate egg,
infection; does not protect the individual from reinfection larvae, protozoan trophozoites Reveals details that cannot be
- Not absolute and cysts; can also reveal seen on saline wet mounts.
presence of RBCs and WBCs.
Diagnosis of Parasitic infection
2 approaches: 2. Kato thick smear (KTS)
1. Clinical approach - Efficient means f diagnosis of intestinal schistosomiasis and
2. Laboratory approach intestinal helminthes.
- Not suitable for examining larvae, cysts or eggs from certain
I. Clinical diagnosis intestinal parasites.
- Done by physicians - Uses a Cellophane presoaked with glycerine-malachite green
- Dependent on: solution for atleast 24h
a. Gathering of information based on signs and symptoms of the o Chemical examination :
disease, during physical examination 1. Occult Blood determination : Hema-Screen Guaiac Slide test
b. History taking - Hema screen developer contains <6% H2O2 and denatured
alcohol.
II. Laboratory diagnosis - (+) blue coloration on the test pad
- Done by medical technologists, & pathologists - Occult blood may be a result of intestinal bleeding caused
Methods : by parasitic organism, but not indicative of such infection.
1. Direct method o Reporting :
- Definitive identification Species, stage, average # per LPF (quantity)
- Requires isolation and identification of parasite from a clinical PRESERVATIVES
specimen
Preservative Advantages Disadvantages
- Isolate through :
a) direct microscopy Polyvinyl alcohol (PVA) For the detection of
trophozoites in Contains mercuric
b) culture Less widely used but diarrheic and mushy chloride and w/
highly recommended for stools that would consequent
2. Indirect method surveys and as a routine escape detection in disposal problems
- Presumptive identification procedure in the lab. other techniques.
- No need for isolation/ identify/ detect Contains mercuric
- Based on Ag- Ab reaction Provides optimum
Schaudinn’s Solution chloride and w/
fixation and
- Referred to as “immune-diagnosis” (Ag/Ab identification) consequent
A constituent of PVA and preservation of
- Specimen: blood (serum) disposal problems
can be both a fixative and structural detail
Not suitable for
preservative specially for the
concentration
SPECIMEN COLLECTION: diagnosis of protozoans
techniques
a. Container: clean, dry free from urine, tight fitting lids
10% Formalin solution Gives satisfactory result
b. Size: about 150 g ; thumb size (semi formed) ; half a teaspoon Widely used for
(watery) compared to MIF and
helminthic infection
c. Label: should contain date and time of collection schaudinn’s
surveys
NB. Liquid / soft stools : best examined w/ an hour of the time of Merthiolate iodine Concentration
passage formaldehyde (MIF) Retains good stain for techniques - Not
a.k.a thimerosal iodine some months; useful reliable for
ROUTINE STOOL EXAMINATION formaldehyde (TIF) : for field collections; specimens that
well preserved have been stored
o Macroscopic / Physical examination : stored in brown glass specimen for a year more than a few
1. Color (light to dark brown; variations: bright red, black/tarry, bottles days
pale yellow, white, gray, clay/putty, green)
SAF fixative solution
2. Consistency (formed, semi formed, soft, watery)
Preservation of material
- Examine for the presence of mucus and blood. Less adherence to the
w/c can be concentrated
o Microscopic examination: slide, although
by the tormol-ether
improved if the slide is
1. Direct fecal smear – detection of trophic forms of amebae acetate technique/ made
coated with albumin
and flagellates. Allowing the observation of motility of the into permanent stained
organisms smear
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STOOL CONCENTRATION TECHNIQUES
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PERMANENT STAINS CLINICAL PARASITOLOGY
Epidemiology: branch of science w/c deals with factors of distribution
STAINS ADVANTAGE DISADVANTAGE of disease.
MODIFIED GOMORI’S -Endemic - Sporadic - Epidemic - Pandemic
TRICHROME Less detail
Oocysts of -Cosmopolitan – found worldwide w/ or w/o sudden increase of
Demonstrates the Cryptosporidium, parasitic infection / incidence
Less time consumed
mitochondrial cyclospora nd o Factors that determine the occurrence of a disease:
Convenient in
myopathies and so called isospora are
identifying of 1. Human factors
range –red fiber. Positive difficult to
intestinal protozoa
structures are the same recognize a. Age - > / extreme age = more susceptible to infection
as H&E stain
b. Gender
Watery specimens
c. Nutritional status
cannot be used;
Results generally are difficult to d. Habits of individual/ customs/ rites
superior (enhanced perform e. Hereditary
IRON HEMATOXYLIN definition of key Oocysts of
STAIN nuclear and Cryptosporidium, 2. Environmental factors
cytoplasmic cyclospora and Factors that favor the survival and maintenance of the parasite
characteristics) isospora are outside the host
difficult to a. Physical factors/ climatic factors
recognize
b. Socioeconomic (poverty favors infection)
POLYCHROME IV
STAIN c. Occupation
Can be used in place Cannot be used
Primarily used to stain o Prevention and control:
of trichrome stain by in specimen
permanent smears -Different strategies for prevention and control
the MIF, PVA or SAF preserved with
prepared from MIF –
fixative method formalin. 1. Treatment of the host
preserved fecal
specimens - Refers to the administration of drugs
CHLORAZOL BLACK E - Reasons for use:
STAIN a. Reduce morbidity
Can be used to detect
Not b. Prevent mortality
fungal filaments in stool; Both fixation and
recommended for
identify the presence of staining occur in a c. Reduce transmission of parasites
materials fixed
protozoa w/c is not single solution
with PVA. 2. Control the animal host
readily detected or
difficult to detect in wet - Treatment with anti-parasitic drugs
prep. - Destruction of the animal
Lack specificity ; - Reason: Reduce chance of transmission from the animal host
use of positive
Sensitive and cost 3. Control the vector host
control is
MODIFIED ACID FAST effective for
mandatory; - Killing the vectors
STAINS detection of these
destruction of - Elimination of breeding grounds
protozoa
trophozoite stage
of parasite 4. Reduction of vehicle contamination
MODIFIED IRON – - Proper sanitation:
HEMATOXYLIN STAIN a. Proper waste disposal
Not
The internal elements b. Treatment of waste (chemically)
recommended for
that distinguish among
Save both time and Schauddin’s - Purification of water
cysts and trophozhoites
personnel use fixative –
can best be visualized - Proper food storage and preparation
preserved or
with a stain that
PVA-preserved 5. Interruption of transmission
enhances the
morphologic features. - Referred to as “barrier protection”
- Use of physical barriers to separate host from the source of
TRICHROME STAIN infection (parasite)
Background debris- green Especially
Protozoa- blue-green to recommended for - A.k.a “spatial protection”
purple cytoplasm identifying features 6. Education
Nuclei & inclusions- red or
purple red and sharply of amoebic cysts and - Information dissemination: Through different media
delineared from trophozoites 7. Immunization of susceptible individuals
background - Acquired by vaccine
- Not for parasite infection
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PROTOZOANS Functions:
i. Metabolism
- Group of eukaryotic organisms ii. Site of food synthesis and storage
- One-celled organisms (unicellular) - stored in the form of glycogen mass/ vacuole or in the
- Has 7 phyla, but 3 are medically important form of chromatoidal body / bar (represents protein
storage; made-up of crystalline RNA)
Subphylum sarcodina
Phylum sarcomastigophora
Subphylum mastihophora 2. Nucleus
Phylum ciliophora - Bounded by nuclear membrane
Phylum apicomplexa Class sporozoea 2 types of nucleus:
a. Vesicular type:
General morphology: - Majority found in protozoans
Two regions of protozoan cell
- Characterized by irregular distribution of chromatin;
1. Cytoplasm appears that there are light areas or spaces in the
- Divisible into 2 portions nucleoplasm
a. Ectoplasm
- on the outer part; peripheral region
- less granular; more homogenous than endoplasm - Chromatin materials in the nucleus
Functions : - Spokeswheel arrangement
NB:
b. Endoplasm Encystation
- found in the inner region that directly surrounds the Trohozoite transform Cyst
nucleus Excystation
– dense/ moderately dense granular
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ENCYSTATION : NB. All are intestinal amoeba except for E. gingivalis found in
the mouth usually at the cavities, teeth and gums. They are
differentiated by the morphology of the nucleus.
- Transformation of trophozoite into a cyst stage
- Caused by adverse conditions in the environment
1. When there is nutritional deficiency MORPHOLOGY OF THE NUCLEUS
2. Changes in the increase toxicity
1. Genus Entamoeba
3. Desiccation
- Characterized by small karyosome (centrally located/
4. Decrease oxygen concentration eccentrical)
5. pH / temperature changes - Has chromatin material (linin network)
6. Overcrowding/ overpopulation
- Has peripheral chromatin w/ either fine granules / course
granules ot regular/ irregular distribution
EXCYSTATION :
2. Genus Endolimax
- Cystic stage becomes trophozoite stage for reproduction
- Characterized by large karyosome and irregular shaped
- Both processes occurs within the host only karyosome with fibrils radiating into periphery
- No peripheral chromatin
PHYLUM SARCOMASTIGOPHORA
SUBPHYLUM SARCODINA A.K.A “ Amoeba/ Amoebae” 3. Genus Iodamoeba
- Characterized by large spherical karyosome surrounded
a. Genus Entamoeba by achromatic globules ( referred to as periendosome; may
- E. histolytica (real pathogen) be clustered at one side)
- E. coli - Lacks peripheral chromatin
- E.gingivalis
- E. dispar CRITERIA FOR IDENTIFICATION
- E. hartmani
b. Genus Endolimax 1. Size – measured in μm
- E. nana 2. Shape and motility
c. Genus Iodamoeba 3. Characteristics of the nucleus
- I. butschii 4. Cytoplasm
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TROPHOZOITE OF INTESTINAL AMOEBA
NUCLEUS CYTOPLASM
SIZE MOTILITY
SPECIES Peripheral Karyosomal
(Usual Range) Pseudopod Number Appearance Inclusion
Chromatin Chromatin
Active ,
Present, fine, Fine granular,
10-60 μm progressive, Small, discrete,
uniform ground glass Erythrocytes (
Entamoeba (15-20 μm directional, One, not visible
granules, evenly
compact. Usually
appearance, not present in E.
histolytica/ – E. dispar ) hyaline fingerlike in unstained
distribute. may
centrally located
clean. If present, dispar) may
dispar (over 20 μm – or blade preparation
be beaded
but occasionally
vacuoles are contain bacteria
E. histolytica) pseudopod , eccentric
appearance very small.
formed rapidly
Present, fine,
Usually non Small, discrete,
uniform
progressive, but One. Not visible compact often
Entamoeba 5-12 μm
may be in unstained
granules, evenly
eccentrically Finely granular Bacteria
hartmanni (8-10 μm ) distributed. May
progressive preparation located but may
be beaded
occasionally be central
appearance
Sluggish, non- Large, discrete,
Similar to E.
progressive, One. Often usually Abundant
Entamoeba 15- 50 μm blunt , usually visible in
histolytica
eccentrically. Coarse, often bacteria, yeasts,
coli (largest ( 20-25 μm) granular unstained
Darker, solid
May be diffused vacuolated and other
protozoan) pseudopod. preparation
ring rather than
and darkly materials
beaded
Formed slowly stained
Moderately
active , with
multiple
Present, fine Small, well-
Entamoeba 5-20 μm pseudopods, vary
One granules, closely defined, usually
Finely granular, Epithelial cells
gingivalis (10-15 μm) from long ,
packed. centrally located
vacuolated and leukocytes
lobose to short
and blunt, often
formed rapidly
Sluggish, usually One,
Endolimax Large, irregular
non progressive, occasionally
nana (smallest 6-12 μm shaped, blot like, Granular,
hyaline, blunt, visible in Usually none Bacteria
intestinal (8-10 μm )
pseudopod, unstained
usually centrally vacuolated
protozoan) formed slowly. preparation
located
Large, usually
centrally located.
Sluggish, usually Surrounded by
non progressive. One. Not usually retractile, Coarsely
Bacteria, yeast,
Iodamoeba 8-20 μm Hyaline, blunt or visible in achromatic granular, maybe
Usually none or other
butschlii (12-15 μm) fingerlike unstained granules. These heavily
materials
pseudopod. preparation. granules are vacuolated
Formed slowly. often not
distinct even in
stained slide.
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CYSTS OF INTESTINAL AMOEBA
NUCLEUS CYTOPLASM
SIZE MOTILITY Peripheral
SPECIES Karyosomal Chromatoidal
(Usual range) Pseudopod Number chromatin/ linin Glycogen
chromatin bodies
network
Usually diffuse.
Present. Concentrated
1-4 in mature
Present. Fine , Elongated bars mass seen
Entamoeba cyst Small, discrete.
10-20 μm uniform in size with bluntly occasionally in
histolytica/ Usually spherical 1-2 occasionally Usually centrally
(12-15 μm) and evenly rounded ends young cyst.
dispar seen in located
distributed (cigars/ sausage/ Stains reddish
immature cyst
rod-like) brown with
iodine
Present.
1-4 in mature
Elongated bars
cyst
Entamoeba 5-10 μm Similar to E. Similar to E. with bluntly Similar to E.
Usually spherical 1-2 occasionally
hartmanni (6-8 μm) histolytica histolytica rounded ends histolytica
seen in
(bar-like or rice
immature cyst
grain)
1-8 in mature Present. Less
Present. Course Usually diffuse.
cyst. Super frequently seen
Usually granules But occasionally
nucleated cyst Large, discrete, than in similar
spherical. irregular in size well-defined
Entamoeba coli with 16 or more usually E. histolytica.
10-35 μm Occasionally & distribution, mass in
(largest seen. eccentrically but Usually splinter-
(15-25 μm) oval, triangular, but often immature cyst.
protozoan) or of another
2 or more
appear more
occasionally like with
Stains reddish
occasionally centrally located pointed ends
shape uniform than in brown with
seen in (broom stick,
trophozoite iodine
immature cysts jagged)
Occasionally,
granules or Usually diffuse.
small oval Concentrated
Endolimax nana 1-4 in mature
Large (blotlike),
masses seen, but mass seen
(smallest 5-10 μm Spherical, ovoid cysts. Less than bodies as seen occasionally in
None usually centrally
intestinal (6-8 μm) or ellipsoidal 4 rarely seen in in Entamoeba young cyst.
located
protozoan) immature cyst species are not Stains reddish
seen (comma, brown with
coccoid, short iodine
curved rods)
Large, usually
eccentrically
Granules
located.
occasionally
Retractile, Compact, well-
Ovoid, present, but
achromatic defined mass.
Iodamoeba 5-20 μm ellipsoidal, chromatoidal
1 in mature cyst None granules on one Stains dark
butschlii (10-12 μm ) triangular, or of bodies as seen
side of brown with
another shape in Entamoeba
karyosome. iodine
species are not
Indistinct in
present
iodine
preparations
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P A T H O G E N E C I T Y AND P A T H O G E N E S I S
2. Colonic perforation
AMOEBIASIS:
- Refers to any clinical condition resulting from infection with - Results into peritonitis (inflammation) and
E. histolytica hemorrhage
- May occur at any area of invasion (usually intestinal) 3. Secondary infection
- Caused by another agent in the area
Intestinal Amoebiasis: 4. Secondary invasion
- Either be asymptomatic or symptomatic - Cause by other agent
- Most common type (85-95% of cases are asymptomatic; - Parasites gain access in blood circulation
5-10% symptomatic )
- Passes formed stool
EXTRAINTESTINAL AMOEBIASIS
a. Acute amoebic colitis (nondysenteric) SITE DESCRIPTION TERM
- Includes abdominal pain / cramps
Secondary to infection in colon
- Frequent dysentery (watery, bloody and mucoid) Most common type of EA;
- Passes watery stool (trophozoite stage) characterized by :
a. Amoebic hepatitis (char. By
b. Chronic amoebic colitis (dysenteric hepatomegaly) “ Hepatic
Liver
b. Amoebic hepatic abcess Amoebiasis”
- Intermittent diarrhea and constipation (central part of abcess is pus-
- Either trophozoite / cystic stage is recovered likened to be “anchovy-sauce”,
reddish brown in color
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I N T E ST I N A L A N D A T R I A L F L A G E L L A T E S
1. Demonstration of parasite
a. Acquired via ingestion of mature
a. Stool specimen
cyst (water-borne), passed through the
b. Duodenal aspirate
stomach then reaches the duodenum –
- Gastrodoudenoscopy
excystation occurs yielding 2
- Nasogastric insertion
trophozoites
Giardiasis : - Diagnostic stage: trophozoite
Can cause c. Enterotest (string test)
Giardia lamblia b. Adheres to mucosa of intestinal wall
“Gay bowel syndrome” - Utilizes string device made
through sucking disks
up of gelatin capsule inside a
spool of nylon string and a
c. Multiplies , then encystation occurs
weight (collection of
in colon, cysts passed in feces
trophozoite)
(formed), and as trophozoite (watery
stool)
2. Serological test
Chilomastix mesnili
Dientamoebiasis : often
Other feature:
asymptomatic Transmitted 1. Demonstration of parasite
“Shows explosive disintegration in
through fecal-oral route
water”
25% diarrhea ,abdominal pain, Stool specimen
– tendency to be swollen in water
Dientamoeba fragilis granules to cytoplasm will exhibit
flatulence, nonspecific (trophozoite stage)
gastrointestinal syptoms; a. Direct fecal
Brownian movement then swings back
Concomitant with pinworm b. SCT
to the normal size – referred to as
infection c. Permanent stains
“HAKANSON phenomenon”
(E. vermicularis)
Pentatrichomonas hominis Commensals
Transmitted through direct
contact: sexual contact.
Trichomoniasis – clinical
condition resulting from T.
vaginalis infection
Females: 50% asymptomatic &
50% symptomatic
s/s : vaginitis/ cervicitis (vaginal
discharge- yellowish in color/
greenish in color/ frothy);
Trichomonas vaginalis pruritus;dysuria;
dyspareunia(painful sexual
contact); hyperemic vaginal
mucosa
Males: generally asymptomatic;
occasionally appear in form of
urethritis & prostatitis
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TROPHOZOITES OF INTESTINAL AND ATRIAL FLAGELLATES
NUMBER OF NUMBER OF
SPECIES LENGTH SHAPE MOTILITY OTHER FEATURES
NUCLEI FLAGELLA
Pear- shaped
Sucking disk occupying ½ to ¾ of
Pyriform shape, 2; not visible in 4 lateral (2
Giardia 10-20μm “Falling Leaf”, ventral surface
tear-drop shape; unstained ventral , 2
lamblia (12-15 μm) flip-flop “old man w/ eyeglasses”
dorsoventrally mounts dorsal)
“monkey face”
flattened
1 or 2. In
Ameboid,
approximately Karyosome usually in form of
pseudopods are
40% organisms cluster of 4-8 granules. No
angular,
Dientamoeba 5-15 um only 1 nucleus peripheral chromatin. Cytoplasm
serrated, or Sluggish None
fragilis (9-15 μm) present. Nuclei is finely granular, vacuolated, and
broad-lobed and
not visible in may contain bacteria. Organism
hyaline; almost
unstained formerly classified as amoeba.
transparent
mounts
1; not visible in
Pentatrichom 8-20 μm 3-5 anterior, Undulating membrane extending
Pear- shaped Rapid, jerking unstained
onas hominis (11-12 μm) 1 posterior length body. Commensal
mounts
Cytostome with
Lemon-shaped, with
6-10 μm 1; not visible in unstained supporting fibrils. Usually
Chilomastix mesnili (7-9 μm)
anterior hyaline knob or
mounts visible in stained
“nipple”
preparation
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BLOOD AND TISSUE FLAGELLATES
Development stages AMASTIGOTE PROMASTIGOTE EPIMASTIGOTE TRYPOMASTIGOTE
Other name Leishmania stage Leptomonas stage Crithidia stage Trypanosome stage
Appearance Generally ellipsoidal/ ovoidal Fusiform in shape/ spindle Fusiform; spiral shape
Fusiform
or spherical shape elongated
Size 3-4 x 2 μm (very small) 14-20 μm in length
Location Insect vector Insect vector Host’s blood and tissue
GENUS LEISHMANIA
CRITERIA Leishmania tropica Leishmania braziliensis Leishmania donovani
Reticuloendothelial cells ,
Within macrophages, skin, mucous
Macrophages of the skin, nearby lymph macrophages of the liver, spleen,
Habitat/ source membranes of the nose, and buccal
nodes bone marrow , intestinal mucosa and
cavity
other body organs
Cutaneous leishmaniasis
Visceral leishmaniasis
Also termed as “Old world
- Affects visceral organs
leishmaniasis”/ oriental sore/ tropical Mucocutaneous leishmaniasis
- Has lesions on the skin; manifested
sore/ “Aleppo button/ Jericho boil or - Initial lesion is “Weeping ulcer”
be fever, hepatomegaly and
Delhi boil or Baghdad boil. (fluid exudes from ulcer)
Disease splenomegaly; in general leads to
- Starts w/ cellular infiltration, then - Also termed
lymphadenopathy
necrosis and ulceration invites secondary
invasion, leading to granuloma “Epundia,” “Chichero ulcer,” “Uta”
A.k.a. “ Kala-azar”, “Dum-dum fever”
formation
or “Death fever”
- Healing w/ scar (2-10 weeks)
Two hosts
a. Man
b. Vector host: sand flies ( Genus phlebotomus- vector host of the old world or Genus Lutzomyia – vector host of the new world)
NB. Acquired via bite of sand flies; two stages involved in life cycle the amastigote and promastigote
a. Leishmania species occur as amatigote stage ( tissue juices and macrophages) in blood ; vector takes a blood meal acquiring the amastigote
b. Amastigote proceeds to the midgut of the vector; changes into promastigote
c. Promastigote multiplies by binary fission; migrates back to the anterior gut then, promastigote blocks the proboscis
Life cycle d. During blood meal, promastigote (infective stage) is injected into the skin.
Life cycle in man:
a. Acquired via bite of vector; promastigote is injected
b. Promastigotes are ingested by the macrophages then transforms into amastigote stage
c. Multiplies w/in the macrophages by binary fission causing rupture of parasitized cell, releasing amastigotes
d. Infects other cells; then form core of parasitized cells (L. tropica: remain localized in the skin & acquired from tissue juices; L. braziliensis: acquired
from tissue juices; L. donovanni: acquired from blood)
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GENUS TRYPANOSOMA
T. rhodesiense T. gambiense
South American trypanosomiasis
OTHER NAME
Or “Chagas disease”
“ African trypanosomiasis ” or “ Old world trypanosomiasis ”
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LIFE CYCLE Two different host: All Stages occur:
a. Man a. Amastigote (found in RES)
b. Vector : “Tsetse flies” from Genus Glossina - Has indirect life b. Promastigote
cycle; (found in human host – transitional stage)
c. Epimatigote ( found in man as transitional
Vector host: stage; in midgut of the vector w/c multiplies)
1. Acquired through blood meal acquiring d. Trypomastigote
trypomastigote ; carried into the midgut of the vector and (“C shape”/ “S shape or U shape”; found in
multiplies through binary fission blood of man – extracellularly; found in
hindgut of vector)
2. Returns to the anterior gut, then transformed into
epimastigote Vector host:
( at a certain time reverts back into trypomastigote) a. Infected during a blood meal:
trypomastigote (infective stage)- carried into
3. Metacyclic trypomastigote infects man through a the midgut then changes into epimastigote
blood meal. and multiplies longitudinally by binary fission
b. Goes into the hindgut (posterior gut)
Life cycle in man: c. Becomes into metacyclic trypomastigotes
1. Acquired via bite of the tse-tse flies, injecting metacyclic then passed in feces of the vector
trypomastigote
Man:
2. Multiplies through binary fission, invades the bloodstream a. Associated w/ the bite of vector and
defacates containing the metacyclic
3. From the blood stream enters the lymph nodes and the trypomastigote, rubbed onto the skin (bite
different organs of the body (tissue spaces) NB. They do not puncture/abrasion/mucosa of the eyes
become intracellular
Localizes in the central nervous system b. Trypomastigote enters and ingested by
macrophages, then transforms into amastigote
then multiplies causing rupture of
macrophages –releases amastigotes – infects
other cells or may transform into
promastigote – epimastigote – into
trypomastigote then enter cells of other
organs.
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PHYLUM CILIOPHORA
Species :
Balantidium coli Shape and
Motility Number of nuclei Other features Pathogenesis
(largest intestinal size
protozoa)
PHYLUM APICOMPLEXA - Has complex life cycle with “alternating sexual and asexual
Class Sporozoa : Subclass Coccidia generations.
A. Blood coccidia 1. Asexual stages:
- Plasmodium falciparum a. Schizont
(actively dividing forms of parasite by multiple fission)
- Plasmodium vivax
b. Merozoites (daughter cells of schizonts)
- Plasmodium malariae
c. Formation of Schizont/ merozoites is termed Schizogony /
- Plasmodium ovale merogony respectively.
- Plasmodium knowlesi (newly discovered) d. Gametogony : formation of gametocytes, following
B. Intestinal coccidia shizogony/ merogony.
- Isospora belli e. Gametocytes : sexually differentiated
- Cryptosporidium parvum i. Microgametocytes – male
- Cyclospora cayetanensis ii. Macrogametocytes- females
- Sarcocystis hominis 2. Sexual stages
a. Syngamy : fussion of macrogamete and microgamete
C. Tissue Coccidia
b. Zygote – product of syngamy
- Toxoplasma gondii
c. Sporogony : development of sphoozoites/ formation of
General characteristics: sphorozoites
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Geographic
Alternation of generation : Species Pathogenesis
Distribution
a. Monoxenous parasite:
- Alternation of generation happens/ occurs in the same host Tertian malaria
Acute malaria/
b. Heteroxenous parasite malignant malaria
- Alternation of generation occurs in different hosts Plasmodium falciparum (black water fever) Tropical regions
- Common cause of
BLOOD COCCIDIA malaria
Plasmodium species - >70%
- Plasmodium falciparum Tertian Malaria
- Plasmodium vivax Benign tertian
Tropical ,
malaria
- Plasmodium malariae subtropics and
Plasmodium vivax - 2nd most common
some temperate
- Plasmodium ovale cause
areas
- <30%
Life cycle: indirect life cycle
Quartan Malaria
Two hosts : man and vector ( mosquito belonging to the Genus Plasmodium malariae - <1% Tropics
Anopheles- only the female anopheles mosquito takes a blood meal)
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Thick smear Thin smear
2 Types of relapse : Relapse Recrudescence
3 drops of blood; 1 cm away
Reappearance of symptoms from thin smear ; 1 cm 1 large drop of blood
Renewed symptoms arising from diameter- circular motion
after a period of w/c the
increase number of persisting
parasites have been absent Not fixed
blood stage forms to clinically
in blood; associated w/ P. (inorder to cause cell lysis of
detectable level; blood has not Fixed w/ methanol
vivax and P. ovale ( due to RBC to undergo
been cleared of parasites; (prevent cell lysis)
subsequent preerythrocytic dehemoglobinized/
associated w/ P. falciparum and
schizogony / activation of dehemoglobination)
probably P. malariae
hypnozoites)
Examined first at the center ; no Examined at the feathery
RBC, WBC & plates & parasites edge/tail; RBC,WBC,platelets and
Pernicious Malaria are seen parasites are seen
- Acute type of disease Must have examined 200-300
- Acute malaria/malignant malaria; associated w/ P. falciparum Must have examined 100 OIF
OIF
- Due to 4 factors: For Rapid detection For species identification
1. Hyperparasitemia
- Due to infection to RBC of all ages (associated w/ black water 2 Methods of staining:
fever –a syndrome of massive intravascular hemolysis w/c results a. Rapid staining : making use of GIEMSA at 10% concentration
hemoglobinuria ( urine becomes dark color/brownish due to Hgb) – (5-15 mins)
2. Cytoadherence b. Regular staining : makes use of 3% GIEMSA – (30-45 mins)
- Based of expression of parasite derived molecules on the surface
of infected red blood cells 3 major considerations/ criteria to examine for malarial parasites:
a. Appearance of infected rbc
Molecules - Size of parasitized cell
- strain specific: infected by P. falciparum only - Shape (P. ovale – jagged/fimbriated )
- Stage specific : expressed only when a parasite starts to divide - Stipplings
(stage prior to division); causes the RBC to become sticky, therefore - Plasmodium falciparum : Maurer’s dots (wedge shape)
causing agglutination: rbc will also adhere in the capillary - Plasmodium vivax : shuffner’s stipplings (small
endothelium – obstruction of capillaries—constriction of capillary – granules)
obstruction of blood flow – hypoxia or anoxia – necrosis - Plasmodium malariae: Zieman’s stipplings
- Plasmodium ovale: Jame’s stipplings
LABORATORY : b. Appearance of the parasite stage
-P. falciparum: only ring forms & gametocyte seen
1. Microscopic examination: c. Parasite stages found in the peripheral blood
Romanowsky- stained (thick and thin blood film by GIEMSA
stain) Fluorescence staining
- Makes use of fluorochromes( acridine orange,
I. Preparation of blood films obtained by capillary or venous benzothiocarboxypurine)
blood - Excited w/ UV light , w/c will give of fluorescence
- Capillary blood : most preferred sample; yields a # of
parasite, especially for P. falciparum
QBC microhematocrit centrifugation method
- Thick & thin blood films are prepared directly (quantitative buffy coat)
- Commercially available ; not exclusive for malarial parasite
II. Venous blood: - Test kits:
- Use of anticoagulant 1. Capillary tubes – coated w/ acridine orange
- NB: clotting may entrap the organisms (filled up w/ blood)
- Preferred anticoagulant is EDTA; prepared 1 h after 2. Caps – used as closures of capillary tube
collection, because it may cause morphological changes of 3. Plastic floats – for insertion into the capillary tube w/
the parasite if prolonged. blood.
- Acridine orange: stains the DNA of the nucleus
- Bright apple green-yellow color
- RNA cytoplasm will be stained yellow or orange in
color
- Provides rapid detection (not for identification)
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(+) 3 lines
1st : control
2. Non – Microscopic tests
2nd: detects HRP-2
I. Immunodiagnosis 3rd: detects Plasmodium aldolase
- Detection of presence of antigen & antibody for
malarial parasite 4. ICT malarial P.f
Sample: serum
II. Molecular diagnosis
Rapid diagnostic tests (RDT) for malaria
- Based on detection of antigen - Includes gene amplification through the method
polymerase chain reaction(PCR)
- Immunochromatographic test ; releies on
immunochromatography ( on the migration of a fluid Mosquito vectors: found in the Philippines
on the surface of a nitrocellulose membrane ); makes - Night biters (6 pm – 6am)
use of adsorbent pad made up of nitrocellulose.
Primary : Anopheles flavirostris
Principle: based on capture of parasite antigen w/ labeled
monoclonal antibodies. Secondary:
- A. litoralis
Malarial Antigens:
- A. maculatus
a. HRP-2 (histidine – rich protein 2)
- A. mangyanus
- Water-soluble protein, that is formed only by P.
falciparum, only by asexual stage including gametocytes - A. balabacencis
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Criteria Plasmodium falciparum Plasmodium vivax Plasmodium malariae Plasmodium ovale
Persistence of
erythrocytic No Yes No Yes
cycle
Shuffner’s stipplings :
Inclusions Maurer’s dots : wedges usually present in all cells Zieman’s stipplings James’ stipplings
except early ring forms
Multiple
Common Occasional Rare Occasional
rings/cells
Multishaped, irregular
ameboid parasite; streamers
Non-ameboid rounded/ Ring shape maintained
of cytoplasm close to large
Growing Heavy ring forms; fine band-shaped solid forms; until late in development;
chromatin dot; vacuole
trophozoite pigment grains chromatin may be hidden by non-ameboid compared to
retained until close to
coarse, dark brown pigment P.vivax
maturity; increasing
amounts of brown pigment
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Criteria Plasmodium falciparum Plasmodium vivax Plasmodium malariae Plasmodium ovale
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Intestinal coccidia Cryptosporidium Sarcocystis hominis / Sarcocystis
Isospora belli Cyclospora cayetanensis
Criteria parvum Sarcocystis suihominis lindemanni
Classification Monoxenous Monoxenous Monoxenous Heteroxenous Heteroxenous
Life cycle 1. Acquired via ingestion of 1. Acquired via ingestion 1. Aquired via ingestion of M a n:
mature oocyst of mature oocyst mature oocyst 1. Acquired via ingestion of the sarcocyst
present in contaminated beef or pork
2. Mature oocyst referred to as 2. Oocyst undergo 2. Encystation occurs NB: sarcocyst – a tissue cyst ; contain
sporolated ; when reaching the excystation in the bradyzoites – one of the two forms of
small intestine undergoes intestine – releasing 3. Release sporozoite and trophozoites; slowly dividing trophozoites,
excystation- release sporozoites sporozoites – sporozoites enter into enterocytes incased in a wall
enter enterocytes 2. On ingestion the sarcocysts ruptures
3. Enters enterocytes & (extracytoplasmic- just 4. Schizogony happens; releasing bradizoites
initiates the process of beneath the cell followed by merogony – 3. Bradizoites become intracellular –
schizogony—merogony – leads membrane of the cell) gametogony enterocytes
to rupture of cell 4. Undergo gametogony
3. undergoes schizogony : 5. Maturation into gametes 5. Maturation then followed by syngamy
4. Merozoites are released w/c produces merozoites 6. Produces a zygote w/c is enclosed w/ a
can either become gametocytes 6. Syngamy—produces wall
or enter another cell and 4. merozoites can zygote then forms a wall 7. Immature oocyst w/ 1 sporoblast –
repeat the process transform into divides into 2 sporoblast – forms a wall
gametocytes – maturation 7. Zygote turns into oocyst ; 8. 2 sporocysts results – undergoes
5. Gametocytes may continue t – syngamy – produces immature oocyst passed in sporogony—producing 4 sporozoites w/in
syngamy – forms a zygote – zygote—then forms a feces 1 sporocysts—8 sporozoites
forms a wall, referred to as wall –oocyst or can enter 9. Mature oocysts passed out in feces
oocyst—passed out in feces another cell 8. Develop 2 sporoblast;
5. Oocyst : Thick –walled develops further to become IntermedIa te host
6. Immature oocyst is passed oocyst (80% of oocyst); 2 sporocysts 1. Acquired via ingestion of sporolated
out thin-walled oocyst oocysts (mature oocyst)
(20% of the oocyst) 9. Sporocysts undergo 2. Enters intestine and ruptures
sporogony outside the host 3. Sporozoites released penetrating the
6. Followed by sporogony intestinal mucosa and enter the blood
7. 20% (thin walled) can 10. Mature oocyst: 2 4. Carried into the endothelium –
rupture its oocyst while sporoblast; 2 sperozoites/ sporozoites transform into schizonts
still w/in the host then sporocysts—ingested – 5. Schizonts undergo schizogony ; then
releases sporozoites results to infection merogony—producing merozoites:
(autoinfection) released from the endothelium
6. Can either become bradizoites – form a
8. The 80% thick-walled wall and become encysted—sarcocysts or
are passed out in the can enter cells and repeat the cycle.
feces – mature oocysts
Diagnostic stage Sarcocysts –
Immature oocysts Mature oocysts Immature oocysts Mature oocysts dead-end
infection
Laboratory 1. Examination of the feces
Diagnosis - Unsporolated oocysts
2. Fluorescent microscopy
1. Demonstration of parasite-
- Autofluorescence 1. Demonstration of parasite
immature oocyst
a. Direct fecal smear – mature oocyst
(Characteristic of the parasite; 1. Direct fecal b. SCT
2. Fluorescent microscopy
no making use of dyes; emit a demonstration c. Fluorescence microscopy
- Autofluorescence
bright blue –green color) - Autofluorescence
d. Modified acid fast staining : kinyoun’s
3. Modified acid fast
3. Modified kinyoun’s method method
- Appears: pink to red color
- Background: green
Methods of identification:
1. DFS (wet mounts)
2. SCT
3. Permanent staining
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TISSUE COCCIDIA
Toxoplasma gondii
Congenital Toxoplasmosis:
-Either monoxenous/ heteroxenous
- manifestations: associated w/ still birth or birth defects w/c
-Monoxenous in its natural habitat include
( Natural host : cats of Family Felidae ) 1. Retinochoroiditis
Life Cycle : 2. Cerebral calcification
In animal host 3. Hydrocephalus or microencephali
a. Passed out in feces of cats, as immature oocyst (ovoidal in
shape; 10-12 μm in diameter; contains a single sporoblast w/c Laboratory Diagnosis:
divides into 2 sporoblast) 1. Demonstration of parasite
b. Forms a wall produsing 2 sporocysts ; then develops 4 - tissue aspirate : tachyzoites
sporozoites on each - biopsy samples : zoitocyst
c. Mature oocysts contains 8 sporozoites (sporulated oocyst- 2. Serological test
infective stage) - detection of Antibodies
d. Undergoes schizogony – merogony – gametogony then - Sabin- Feldman Dye test
syngamy
e. Zygote becomes an oocyst then passed out in feces • Based on detection of Ab from Pt. serum by reacting it
w/ live toxoplasma org. in a presence of dye (methylene
In man blue)
a. Heteroxenous : intermediate in other animals and in man • Based on the refractoriness of toxoplasma org. to the
; definitive for cats methylene blue dye in the presence of specific
b. Acquired via ingestion of mature oocyst w/c is shed in antibodies
cat feces • (+) no stain
c. Oocyst wall ruptures releasing sporozoites; • (--) stained in blue color
d. Sporozoites penetrate intestinal mucosa to reach blood
circulation; then carried into different tissues and organs
e. Sporozoites transform into “tachyzoites”(fast dividing: 4-
8 x2-3 μm; cresent shape; one end tapered and rounded at
one end w/ a single nucleus; seen in the early stages of the
disease)
f. Multiplies by binary fission w/c is “endodyogeny”- cell
membrane is formed first before nuclear division
g. Overtime tachyzoites transform into bradyzoites (seen on
the latter stages of the disease)
h. Bradyzoites forms a wall becoming a “zoitocyst”(found in
skeletal muscles, myocardium and also in the brain, eyes
particularly in the retina of the eye)—causes dead-end
infection
Pathogenesis :
“Toxoplasmosis ”
- In man :majority 90% asymptomatic, especially in
immunocompetent
- s/s in immunocompromised person:
starts with non-specific flu-like (fever, myalgia,
lymphadenopathy, pneumonia, encephalomyelitis,
myocarditis, and retinochoroiditis – leads to
blindness
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HELMINTHS Alimentary system
General Life Cycle:
1. Egg
- Undergoes embryonation
2. Larva
- Goes through 4 stages of development
Excretory system
Stages Symbol Other name
hickenings of subcutaneous tissues
1st stage L1s Rhabditiform
Nervous system
2nd stage L2s Filariform
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Class
Adenophorea Trichuris trichiura Capillaria philippinensis Capillaria hepatica Trichinella spiralis
CRITERIA
Other name “Whip-worms” “Pudoc worm” “Capillary liver worm” “Trichina worm”
Description Typical female: oviparous (1 row of
eggs : 8-10 eggs)
Oviparous Atypical female: larviparous(2-3 rows Larviparous
larviparous
Cosmopolitan of eggs: 40-45 eggs) Parasite of animals such as rats, other
“Autoheteroxenous parasite”
(common in the tropics & subtropics) Common in : rodents, and dogs
Philippines , Thailand , Korea, Japan,
Taiwan, Iran, Egypt, Italy and Spain
Adult stage Male : 30-45 mm
Female: 35-50 mm Male: 1.5x 0.04 mm
Anterior 3/5 : attenuated whip-like 3/5 Female : 3.5 mm x 0.06 mm
traversed by a narrow esophagus resembling Male : 1.5-3.9mm x 23-28 μm Anterior end: slender, w/ a small
string of beads.
Posterior: more robust , 2/5 containing the Female :2.3-5.3mm x 29-47μm Resembles Trichuris trichiura orbicular nonpapillated mouth
intestine and a single set of reproductive ( 2- 5 mm in length) Posterior end: bluntly rounded in the
organs. female and ventrally curved w/ two
Male – coiled posterior lobular caudal appendages in male.
Female – bluntly rounded end
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CLASS SECERNENTEA
CRITERIA Ascaris lumbricoides Enterobius vermicularis Toxocara canis Toxocara cati
Other Name “Dog ascaria” / “ dog “Cat ascaria” / “ cat round
“Giant intestinal round worm” “Pin worm” / “seatworm” round worm” worm”
- Said to be “largest intestinal nematode” Old name: “Oxyuris vermicularis”
“ Visceral larva migrans” / “Ocular larva migrans ”
Adult Male: 150-200 x 2-4 mm Male: 2-5 x 0.1 mm
Female: 200-350 x 4-6 mm Female : 8-13 x 0.3- 0.5 mm Similar to Ascaris lumbricoides in appearance but
Smooth cuticle, unstriated , Distinctive feature: only a quarter to half its size.
nonsegmented. - Cephalic alae NB. Toxocara : body is bent ventrally
- Trilobite lips - Esophageal bulb
Egg a. Fertilized : 60x 45 μm Size: 50-60 x20-30 μm Size: 85 x75 μ Size: 65-70 μ in
Broadly ovoid; golden brown in color; - Thick-walled ; colorless shell; Superficially pitted diameter
unembryonated at oviposition. - shell flattened on one side
Thick-shelled - coiled larva developing in egg
Inner: non-permeable , lipoidal vitelline
membrane - “D-shape”
Middle: thick, transparent, glycogen - embryonated
membrane
Outer: coarsely mammilated, albuminous Resemble those of Ascaris, but are larger, less
layer elongate and have thinner shell and albuminoid
b. Unfertilized : 88-94 x 39-44 μm outer covering.
Longer and narrower than fertilized egg;
completely filled with disorganized, highly
retractile granules
Thinner shell and irregular mammilated,
albuminous layer
Epidemiology Cosmopolitan Cosmopolitan
Life cycle a. acquired via ingestion of embryonated
egg (L2s) Same as Ascaris lumbricoides
b. enters small intestine and hatches, Animal:
releasing larva (L2s- filaria form) a. ingestion of embryonated egg
a. acquired via ingestion of b. egg hatches in the small intestine; then larva
c. penetrates intestinal mucosa – enters embryonated egg
portal circulation- liver released penetrates the heart and lungs--- esophagus
d. from liver to the heart; then enters the b. egg hatches and releases larva in – maturation occurs in the intestine
lungs (undergoes molting : L3s-L4s) small intestine c. unembryonated egg is then passed out
e. ascends to the alveolar tree c. matures into adult in the cecum d. embryonization occurs in the soil
f. esophagus to small intestine (development (MT: 3-4 weeks; LS: 1-2 months) Man:
to adult stage) d. copulation occurs; female crawls a. ingestion of embryonated egg
MT: 2 months b. egg hatches releasing larva, enters the blood
LS: 10-12 months
out through the anus (night time)
e. eggs embryonate (4-6 hours) circulation
g. lays eggs and then passed into the feces c. larva is then carried into the visceral organs of the
as unembryonated egg immediately after release body, wherein they remain as larva stage, thus termed
h. into the soil – becomes embryonated f. autoinfection “visveral larva migrans”
after 1-2 weeks d. can infect eyes – “ocular larva migrans”
i. causes soil-transmitted parasite
Pathogenesis “Ascariasis” “Enterobiasis” / “Oxyuriasis” “ Visceral larva migrans” – infection of visceral
Light infections: asymptomatic due to female adult organs
Manifestations may be due to : - migration of the gravid females from “Ocular larva migrans” – eye infection
1. Migrating larvae the cecum to the anus, causes intense
- causes pneumonitis itching in the anal region referred to as
- eosinophilia associated w/ Loeffler’s “Pruritus ani”
syndrome (transient eosinophilic - insomnia
infiltration of the lungs) - scratching of anal area
2. Development of adult worms
Due to wandering female adult
- to peritoneum causing peritonitis
Gastrointestinal symptoms; decreased growth - to appendix causing appendicitis
rate; intestinal obstruction (can be entangled - may cause vaginitis
forming ascaris bolus blocking intestinal - endometritis, salphingitis (infects
bowel); downstream wandering ( can enter uterus, ovaries etc)
appendix causing appendicitis) or can cause
upstream wandering
Diagnosis Demonstration of parasite Demonstration of parasite: - eosinophilia
1. DFS 1. perianal swab : Graham’s scotch - concentration techniques
2. Stool con’c techniques
3. KTS tape method (adult female) - serology: Ab detection – ELISA on serum
4. Kato-katz 2. beneath the nail bed swabs
5. Sputum sample : larvae
x-ray examination ( bolus)
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HOOKWORM SPECIES
Criteria Necator americanus Ancylostoma duodenale Ancylostoma caninum Ancylostoma braziliense
Other
“New world hookworm” “Old world hookworm” “Dog hookworm” “Cat hookworm”
name
Adult Resembles ancylostoma but
smaller; head is sharply bent
in relation to the rest of the Adult worm: grayish white / pinkish; head is slightly bent
body, forming a definite hook Male : 1 cm x 0.5mm
shape at the anterior end Female: somewhat longer and stouter
Male: 5-9 mm long
Female: 1cm long
Egg Size: 64-76 μm x 36-40 μm
Unsegmented; 4-8 egg stage
Identical to Necator Somewhat smaller compared to Necator eggs
Shell is thin and colorless
Regularly oval
Buccal A pair of semilunar cutting
Two ventral pairs of fused Two ventral pairs of unfused
capsule plates Three ventral pairs of teeth
teeth teeth
Median teeth
Copulatory Longer than broad Short and broad Large, flame-shaped As broad as long
bursa Dorsal rays- deep cleft and Dorsal rays – shallow cleft Rays – long and slender Rays – stunted
tips bipartite and tips tripartite
Two spicules – fused and Two spicules – unfused and
barbed not barbed
Pathogenesis “Necatoriasis”
a. Larval penetration
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Strongyloides stercoralis b. Isolated by SCT
- Host specific - Facultative parasite c. Caproculture technique
- Baermann Technique: a culture technique, w/c uses a funnel
Parasitic existence Free-living existence apparatus/method
- A fresh stool is placed in a wire mesh, then wrapped w/ cloth (several
Only female adult ; no male layer of the gauze / cloth)
Parthenogenic female: able to
Both male and female - Placed in a container w/ water w/ the funnel, the rhabditiform will
produce a row of offspring w/o pass through the wire gauze
the fertilization of the male.
- From gastroendoscopy
3 Types of Life Cycle: - Enterotest
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 29
FILARIA SPECIES
Wuchereria Onchocerca Mansonella Mansonella Mansonella
CRITERIA
bancrofti Brugia malayi Loa loa volvolus perstans ozzardi streptocerca
Habitat Lymphatic Lymphatic Subcutaneous Subcutaneous Mesenteries Subcutaneous Subcutaneous
tissues tissues (develop tissues tissues( does not
in fixed nodules enter blood
) – does not stream)
enter blood
stream
Size Thick filariae Thick filariae Thick filariae Thick filariae Thin filariae Thin filariae Thin filariae
(width
compared to
rbc)
Sheath Yes Yes Yes none none none none
Giemsa stain Unstained Stained Unstained none none none none
Hematoxylin Stained unstained Stained none none none none
Cephalic Short (as long Long(longer Short(as long as long short Slightly longer short
space as broad) than broad) broad) than broad
Nuclei Discrete; Compact; compact Moderately compact Compact Start in the
regularly spaced overlapping, compact anterior as
in 2-3 rows irregularly single row of 10-
spaced 20/more nuclei
Tail Tapered w/ Tapered w/ 2 Tapered and Tapered Bluntly rounded; Long and Bluntly, rounded
single row of conspicuous coiled w/in the typically flexed, nuclei extend to slender; devoid , bent in
nuclei; no nuclei terminal nuclei sheath; nuclei free from nuclei the tip of nuclei shepherd’s crook
in tip are irregularly shape; nuclei
spaced to the tip almost to tip
Distribution Tropics and Southeast Asia, West & Central Africa, South & Africa, South South and West and
subtropics Indian America Central America and Central Central America, Central Africa
subcontinents America Caribbean
Philippines Camarines Sur, Palawan, Eastern none none none none none
Camarines Samar , Agusan,
Norte, Albay, Sulu
Sorsogon,
Masbate,
Palawan,Mt.
Province,
Quezon ,
Mindoro,
Romblon,
Marinduque,
Bohol, Samar,
Leyte, Mindanao
Province
Rhythmical Nocturnally Nocturnally Diurnally None Aperiodic ( no Aperiodic ( no None
appearance/ periodic periodic periodic rhythm or rhythm or
occurrence (mf is found in 10pm – 2am (found at day pattern in blood; pattern in blood;
on PB either at day Nocturnally time) found anytime) found anytime)
peripheral time/ the night subperiodic
blood time) (peak con’c is at
night)
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 30
FILARIA SPECIES
CRITERIA
Wuchereria Brugia malayi Loa loa Onchocerca Mansonella Mansonella Mansonella
bancrofti volvolus perstans ozzardi streptocerca
Pathogenesis Bancrofts/ Malayan/ “Loaiasis” “Onchocercomata” Calabar-like Asymptomatic Characterized by
bancroftian Brugian filariasis “calabar – a lesion on the swellings, infection: but pruritic
filariasis (upper swelling” – skin; nodular and pruritus, hives, inguinal dermatitis w/
(lower extremities) erythematous erythematous fever and adenopathy, hypopigmented
extremities) swelling in the lesion on the skin headache; pruritic and macules and
Chyluria (milky skin about 5- w/c is 1-5 cm in “kampala or maculopapular inguinal
urine) 10cm in diameter. Uganda eye skin lesions , adenopathy
diameter (also “Ocular worm” arthritis , fever
known as involvement”- and eosinophilia
Fugitive associated w/ has been
swelling) blindness – reported.
Migrates to the “blinding
eyes – filariasis” or river
“Eyeworm”/ blindness
African
eyeworm
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Life Cycle : PHYLUM PLATYHELMINTHES
• Order Pseudophyllidea
- Diphyllobothrium latum
• Order Cyclophyllidea
- Taenia solium
- Taenia saginata
- Hymenolepis nana
- Hymenolepis diminuta
- Dipylidium caninum
- Echinococcus granulosus
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DIVISIONS: TWO TYPES OF PROGLOTTIDS
a. Scolex : anterior end of the body; a muscular organ which is
described as the “hold fast” or the attachment organ. Apolytic Anapolytic
2 types Detaches the main body of the Refers to the proglottids that
Bothriate worm to release eggs (apolysis) detach the body of worm only
- Spindle shape or spatulate or spoon- after exhausting the eggs
shaped Characteristic of Cyclophyllidea Characteristic of
- Has sucking grooves w/c is referred to as Pseudophyllidea
“Bothria/ bothrium”
- One on the mid ventral and one on the
middorsal Other characteristic:
- Ex: members of Order Pseudophyllidea - No digestive system : obtains nutrition through the
Acetabulate integument
- Quadrate scolex - Integument : counterpart of cuticle; w/ microvilli referred
to as “Microtriches”
- Has muscular suckers termed
as“Acetabula” - No vascular system
- Ex: members of Order Cyclophyllidea - Nervous and excretory system present
- Rostellum : a projection at the apex of the
scolex; it may bear hooks or spine - Reproductive system:
Male: lies posterior in the dorsal region of each
b. Neck segment
- Found behind the scolex Female: anteriorly on the ventral region of each
- Unsegmented ; narrowest part; region of segment
growth Genital pore: where the female and male
- NB: the strobili proliferates from the neck reproductive system meets; also used as an
identification marker for adult worms
c. Strobila
- Consists of series of segments
(referred to as proglottids)
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 33
Order Order Cyclophyllidea
Pseudophyllidea
CRITERIA
Diphyllobotrium Taenia saginata Taenia solium Hymenolepis Hymenolepis Dipylidium Echinococcus
latum nana diminuta caninum granulosus
Common Fish tapeworm /
name/ other broad tapeworm Hydatid
Beef tapeworm Pork tapeworm Dwarf tapeworm Rat tapeworm Dog tapeworm
name / broad fish tapeworm
tapeworm
Common One; various
One; various One; various
intermediate Two; copepods arthropods
One; cattle One; pig arthropods arthropods One; sheep
host and fish (beetles, fleas)
(beetles, fleas) (fleas, dog lice)
or none
Definitive Cats & dogs
Man Man Man Man Man Man
host (man)
Mode of Ingestion of
transmission cysticercoid in
Ingestion of
Ingestion of infected Ingestion of
plerocercoid Ingestion of Ingestion of
cysticercus in arthropod or by cysticercoid in
(sparganum) in cysticercus in cysticercoid in Ingestion of eggs
infected direct ingestion infected
flesh of infected infected beef fleas, lice
Pork of egg; arthropod
fish
autoinfection
may occur
Prepatent
3-5 weeks 10-12 weeks 5-12 weeks 2-3 weeks -3 weeks 3-4 weeks 5 months or so
period
Normal life Perhaps many
span Up to 25 years Up to 25 years Up to 25 years years as a result Usually < 1 year Usually < year 10 or > years
of autoinfection
Egg stage Operculated
(immature/unem
bryonated) : Non – Non – Non – Non – Non – Non –
with operculum; operculated operculated operculated operculated operculated operculated
a lid like (mature/ (mature/ (mature/ (mature/ (mature/ (mature/
opening through embryonated) embryonated) embryonated) embryonated) embryonated) embryonated)
w/c the larva
escapes
Oncosphere
(L1s w/in the
egg; contain
Ciliated Non-ciliated Non-ciliated Non-ciliated Non-ciliated Non-ciliated Non-ciliated
6 hook
embryo;
“Hexecanth”
Metacestode Hydatid cysts :
Cystic larvae : Cystic larvae :
Cystic latvae : Cystic latvae : Cystic latvae : fluid filled w/
Solid larvae cysticercus; filled cysticercus; filled
(encysted cysticercoid; not cysticercoid; not cysticercoid; not brood capsule
(procercoid: w/ fluid ; has w/ fluid ; has
larva in fully developed fully developed fully developed that contain
elongated, w/ single single
extraintestin invaginated invaginated invaginated protoscolices;
free scolex) invaginated invaginated
al sites) scolex scolex scolex uniocular
scolex scolex
/multiocular
Adult stage
4-10 m 4-12 m 1.5-8 m 2.5-4.0 cm 20-60 cm 10-70 cm
(length)
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 34
REPRODUCTIVE ORGANS
Order Order Cyclophyllidea
Pseudophyllidea
CRITERIA
Diphyllobotrium Taenia saginata Taenia solium Hymenolepis Hymenolepis Dipylidium Echinococcus
latum nana diminuta caninum granulosus
Genital pore Central / Lateral w/ Lateral w/ Bilateral; double-
midventral part regular irregular Unilateral Unilateral pored; one on Lateral
of each segment alternation alternation each side
Uterus Central; 4-17 lateral 15-30 lateral Reticular filled 12-15 lateral
Sacculate Sacculate
coiled/rosette branches uterine branches w/ egg capsules branches
Uterine pore Present Absent Absent Absent Absent Absent Absent
Gravid Broader than Longer than Longer than
Broader than Broader than Longer than
proglottid long broad broad V- shaped
long long broad
(3x11 mm) (11x5 mm) (19 x 17mm )
Type of
Anapolytic Apolytic Apolytic Apolytic Apolytic Apolytic Apolytic
proglottid
Scolex Spatulate Quadrate Quadrate Knoblike but not Knoblike but not 0.2-0.5mm in Globular but not
(3x1mm) (1mm in diam) (1-2mm in diam) usually seen usually seen diam usually seen
2 slit-like
sucking grooves 4 suckers 4 suckers 4 suckers 4 suckers 4 suckers 4 suckers
(bothria)
Short,
Rostellum w/ invaginated Conical refractile Rostellum with
No rostellum & No rostellum or Rudimentary
double crown of rostellum with rostellum w/ 1-7 double crown of
hooks hooks w/o rostellum
25-30 hooks single row of circlets of hooks 30-36 hooks
20-30 hooks
Ova 70-60 μm; more
70x45 μm,
44x35 μm nearly circular shape
ovoid, yellow-
spheroidal, pale, yellowish, outer
brown, contains 25-40 μm,
31 x 43μm, outer membrane membrane
abundant yolk spherical hyaline
spheroidal, forms thin shell forms
granules, and thin-shelled,
yellow-brown, and rigid inner moderately thick
moderately Indistinguishable contains
thick radially membrane has 2 shell and inner Similar to those
thick-shelled w/ from those of T. hexacanth
striated shell, polar thickening membrane has 2 of taenia ova
inconspicuous solium embryo; 8-15
and contains but 4-8 polar
operculum and eggs enclosed in
hexacanth filaments, thickenings but
usually a small a membranous
embryo encloses a no filaments,
knob at capsule
hexacanth encloses a
aboperculum
embryo hexacanth
end
embryo
Diagnostic Eggs are
Eggs are
problems/ identical to
identical to
notes those of T.
Eggs are those of Taenia
saginata; one is Gravid
sometimes solium, Sometimes Should not be
less likely to find proglottid Cyst shows a
confused w/ ordinarily can confused w/ confused w/ H.
eggs in feces resemble rice sharp outline,
eggs of distinguish eggs of nana since eggs
than with T. grains(dry) or and fluid levels
Paragonimus; between species Hymenolepis lack polar
saginata cucumber seeds can sometimes
eggs are only by diminuta; filaments;
(handle all (moist); dogs be detected w/in
unembryonated examination of rodents serve as rodents serve as
proglottids w/ &cats serve as it.
when passed in gravid reservoir host reservoir host
extreme care reservoir hosts
feces proglottids; eggs
since T. solium
can be confused
eggs are
w/ pollen grains
infective)
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 35
LABORATORY DIAGNOSIS
Order Pseudophyllidea Order Cyclophyllidea
Diphyllobotrium Taenia Taenia Dipylidium
latum saginata solium Hymenolepis nana Hymenolepis diminuta caninum Echinococcus granulosus
a. Taeniasis : Demonstration of
- Eggs in feces proglottids or, more rarely,
- Gravid proglottids Demonstration of egg packets in stool
Embryonated eggs
b. Cysticercosis : in stool CT, ultrasonography , and
- Tissue biopsy radionucleotide scans
- X-ray examination Demonstration of
Demonstration of - serology proglottids or, more Casoni’s intradermal test:
eggs in feces rarely, egg packets Demonstration of immediate hypersensitivity
(sputum), Caproantigen detection: in stool Embryonated eggs in Demonstration test; uses antigen from
proglottids and immunological (ELISA) stool of proglottids hydatid fluid, injected
scolex in feces detection of parasite Radiographic or, more rarely, intradermally on 1 arm &
material in the feces of specific Demonstration of egg packets in equal volume of saline as a
PCR : performed on the host; uses polyclonal demonstration of proglottids or, more stool control on the other arm.
samples of purified antibodies from rabbits the calcified cyst rarely, egg packets in (+) large wheal; about 5 cm
egg hyperimmunized w/ adult a. biopsy stool in diameter w/ multiple
worm products while b. endoscopic pseudopodial projections
others used both rabbit examination w/in 20-30 min & fades
polyclonal and murine c. computer after 1 hr.
monoclonal antibodies tomography Exploration puncture of the
(brain cyst) cyst: yields hydatid fluid &
demons. of solices in
hydatid sand.
PATHOGENESIS
Order Pseudophyllidea Order Cyclophyllidea
Diphyllobotrium Taenia Taenia Hymenolepis nana Hymenolepis diminuta Dipylidium Echinococcus granulosus
latum saginata solium caninum
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 36
CLASS TREMATODA • Heterophyes heterophyes: w/ genital sucker fused w/ the
- Known as “ Flukes ” ventral sucker
- Subclass Digenea
- Digestive system :
- Characterized by alternation of generation
1. Liver flukes Characterized by the oral cavity surrounded by the oral
- Fasciola hepatica - Clonorchis sinensis sucker --- pharynx---esophagus ( bifurcated: divided into
- Opistorchis felineus - Dicrocoelium dendriticum two)--- intestine(does not open exteriorly ); incomplete
2. Intestinal flukes digestive system; inverted “Y” shape
- Fasciolopsis buski - Echinostoma ilocanum
- Heterophyes heterophyes - Metagonimus yokogawai - Reproductive system
3. Lung flukes
- Paragonimus westermani Ovary – only 1 for each fluke shapes:
4. Blood flukes a. Round/subglobose
- Schistosoma japonicum - Schistosoma mansoni
- Schistosoma haematobium b. Lobe/ lobate
c. Branched or dendritic (highly branched)
Groups based on reproductive system: ferens, ejaculatory ducts, etc.
1. Monoecious
- One body w/ both sexual organs Testes – has 2 testes; clue for identification
- Includes intestinal & liver; lung flukes Shapes:
a. Ovoid testes
2. Dioecious
b. Lobed
- Include the blood flukes
c. Branched/dendritic
General characteristics: Appearance:
Monoecious Flukes a. Tandem: one behind the other
Gross morphology b. Side by side
- Flat, Leaf-shaped; unsegmented c. Oblique or diagonal: usually posterior to the
ovary, except for Dicrocoelium dendriticum
- Trematoda : body with holes
- Anterior end: Vitellaria –a yolk gland; located on the lateral
margins
• Oral sucker : for attachment; termed as “Acetabula” ;
surrounds the oral end of adult worm Morphology:
• Ventral sucker: acetabellum for attachment a. Can be branched or dendritic
• Genital sucker: referred to as the “ gonotyl” ; common b. Can be granular or aggregates
with the “heterophyids” c. Follicular
Ex: Metagonimus yokogawai : separate
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 37
MONOECIOUS FLUKES
Liver Flukes Intestinal Flukes Lung Fluke
Criteria Fasciola Clonorchis Opistorchis Dicrocoelium Fasciolopsis Echinostoma Heterophyes Metagonimus Paragonimus
hepatica sinensis felineus dendriticum buski ilocanum heterophyes yokogawai westermani
Adult 10-25 x3- 7-12 x 2-3 5-14 x 1.5-2.5 20-75 x 8-20 2.5-6.5 x 1- 1.0-1.7 x 0.3- 8-15 x 4-8
30 x13 mm 2 x 0.5 mm
size 5mm mm mm mm 1.35 mm 0.4 mm mm
Appeara Active:
nce Pointed spoon-
Narrow
anterior ; shaped;
Elongate- anterior,
Leaf – rounded Resembles C. Lancet- Attenuated Resembles H. preserved
ovoidal in rounded
shaped posterior ; sinensis shaped at both ends heteropyes state: oval,
shape posterior
“Bottle neck flattened,
“Pyriform”
appearance” “Coffee-
bean-shaped”
Integu Scales vary
Scales are
-ment in size,
narrow and
pattern & With spines Resembles H. Scale-like
Aspinose Aspinose Aspinose Spinose closely set,
distribution, and scales heteropyes spines
numerous in
but posterior
the anterior
is aspinose
Ovary Small and
Small, oval
Small and subglobose, Round/
Branched and slightly Branched Subglobose Subglobose Lobed
slightly lobed posterior to lobed
lobed
the testes
Uterus Short and Loosely Coiled in the Coiled Coiled Coiled Coiled Coiled
convoluted coiled posterior 2/3
Testes Highly Deeply lobed Lobed, Slightly Highly Deeply Ovoid, side Ovoid, Lobed,
dendritic; in or branched oblique to lobed, dendritic, in lobed, in by side in obliquely oblique to
tandem in in tandem in each other in oblique to tandem in tandem in posterior 5th side by side each other
the 2nd & the posterior the posterior each other posterior ½ posterior ½ in posterior or nearly
3rd fourths 3rd 4th 5th side by side
at the
posterior
third
Vitella Highly Granular, Numerous, Follicular in Highly Medium- Large, Large, Branched,
-ria branched in aggregates transversely middle branched in sized follicles polygonal polygonal lateral for
the lateral extending compressed lateral fields the lateral in posterior follicles in follicles in the entire
and through in the and ¾ lateral each lateral each lateral length of the
posterior middle 3rd middle 3rd posterior fields posterior posterior body
portions lateral fields lateral fields portions third third
Ova 130-150 x 63 28-35 x 12-19 30 x 11 μm 38-45 x 22- 130-140 x 80- 83 x 58-69 28-30 x 15-17 Similar to H. 70 -100 x 50-
-90 μm μm Elongate- 30 μm 85 μm μm μm heterophyes 60 μm
Ovoid, Broadly ovoid; Asymmetrica “Hen’s egg Straw- Ovoid, Similar to H. Yellowish-
“Hen’s egg- ovoid, narrower lly ovoidal shaped; colored distinct heterophyes brown to
shaped; light “Old than C. dark brown identical to ,ovoid, small opercular dark golden
yellowish- fashioned sinensis ova; in color, F. hepatica; operculum shoulder brown, shape
brown;” electric light broad convex thin, varies
small, flat bulb”, light yellowish- operculum transparent greatly, some
operculum at yellow brown, shell, small, asymmetrical
one end brown, operculum slightly ; thick shell
convex fits into a convex w/ flattened
operculum thickened operculum operculum
rim of shell,
minute
thickening at
the
aboperculum
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 38
MONOECIOUS FLUKES
Liver Flukes Intestinal Flukes Lung Fluke
Criteria
Fasciola Clonorchis Opistorchis Dicrocoelium Fasciolopsis Echinostoma Heterophyes Metagonimus Paragonimus
hepatica sinensis felineus dendriticum buski ilocanum heterophyes yokogawai westermani
“Von Seibold
“Oriental
“Giant fluke or
Common “Sheep liver liver fluke or “ Cat liver “Lancet liver “ Garrison’s “Yokogawai “Oriental
Name fluke” chinese liver fluke” fluke” intestinal fluke” dwarf fluke” lung fluke”
fluke” fluke” intestinal
fluke”
Largest Pyriform in
Other Bottle- neck
fluke ; has Largest fluke Relatively shape; Pyriform in
descrip in
-tion conical of man small smallest but shape
appearance
projections the deadliest
Egg stage
Operculated Operculated Operculated Operculated Operculated Operculated Operculated Operculated Operculated
, immature , mature , mature , mature , immature , immature , mature , mature , immature
Meta Lophocercus
Lophocercus, Lophocercus, Lophocercus Lophocercus Lophocercus, Lophocercus, Microcercus,
-cercaria , simple
stage keel tailed keel tailed , simpletailed , simpletailed keel tailed keel tailed knoblike tail
tailed
Other Cattles;
Definitive herbivores; Man; dogs; water Dogs; pigs; Dogs; rats; Animals ; Animals ; Animals ;
host Cats; man
cattles, cats buffalos ; man man man man man
goats; man man
Snail from Snails from
Snail from
Genus Genus
Snail of Snail from the Genus Snail from Snail
Parafossanul Gyraulus,
1st inter Snails from
us, Bulinus; Snail from Genus Genus Convexiuscul Pironella Genus Antemelania
-mediate Genus Alocinma; Genus Zebrina, Segmentina, us, (egyot) and Thiara, and asperata
host Lymnea Bithynia Helicella and Hippeutid , Hippeutis( Genus Gemilsulcopi (Brotia
Semisul
cospira; Cionella Gyraulus H. Cerithidea ra libertine asperata)
(japan)
Melanoides umbilicalis)
Aquatic
Aquatic plants
plants From Trapa Snail from
Crustaceans
Ipomea spp.(water Genus FishSundathelph
obscura Fish Fish
Ants
caltrop), Pila,(kuhol – Fish from
From usa
2nd inter
-mediate
(kangkong) belonging to belonging to “Formica
Eliocharis Pila luzonica Genus Odontobutis philippina
host & the Family the Family
fusca”
tuberosa ; Genus Acanthogobi obscurus; (Parathelphu
Nasturtium Cyprinidae Cyprinidae (water Vivipara us
officinate chestnut), (suso - V.
Salmo perryi sa
(water Zizania angularis ) grapsoides )
cress) (water
bamboo)
Ingestion of Accidental 2nd IH Ingestion of Ingestion of Ingestion of Ingestion of
Mode of Ingestion of Ingestion of
metacercaria ingestion of ingested encysted meta meta cercaria
trans- encysted fish carrying
mission from 2nd ants carrying carrying metacercaria -cercarian -cercarian from the 2nd
metacercaria metacercaria
host metacercaria metacercaria from 2nd IH stage stage IH
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 39
MONOECIOUS FLUKES
Liver Flukes Intestinal Flukes Lung Fluke
Criteria
Fasciola Clonorchis Opistorchis Dicrocoelium Fasciolopsis Echinostoma Heterophyes Metagonimu Paragonimus
hepatica sinensis felineus dendriticum buski ilocanum heterophyes s yokogawai westermani
Facioliasis Clonorchiasis Opistorchiasis Dicrocoeliasis Fasciolopsiasis Echinostomiasis Paragonimiasis
Acute stage: Adult stage Similar to Manifested by: Inflammation Similar to Similar to other intestinal Manifestations:
Associated w/ found in the Clonorchis Traumatic due to Fasciolopsiasis fluke infection; does not Similar to P. TB
migration of intrahepatic sinensis damage; attachment ; Does not cause cause obstruction Cellular
adult stage bile ducts hyperplasis of ulceration; obstruction due Can become ectopic due infiltration
leading to resulting to biliary obstruction of to its small size to its size: accompanied by
traumatic “trauma epithelium; intestinal Heart: myocarditis granuloma
damage;toxic damage”; Inflammation lumen;toxic leading to heart failure to leading to
irritation hyperplasia of of bile duct; and allergic death fibrosis
causing biliary Fibrosis symptoms CNS: to the brain leading s/s:
necrosis of epithelia; to neurologic cough
liver , inflammation manifestations chest pain
referred to as of bile ducts dyspnea
“liver rot” referred as hemoptysis
Chronic “cholangitis”; NB: usually
stage: can enter misdiagnosed as
Clinical associated w/ gallbladder pulmonary
the causing tuberculosis
features maturation of “cholecystitis”;
worms in the fibrosis
hepatic bile referred to as
ducts leading “cholelithiasis”
to biliary –formation of
obstruction; gallbladder
inflammation stones ; toxic
to “fibrosis” irritation
Halzuon – causing
pharyngeal “cholangio-
fascioliasis ; carcinoma
temporary
lodgement of
immature
worm;
manisfested
by dysphagia
&dyspnea
Demonstrati Demonstrati Demonstrati Demonstrati Demonstrati Demonstration Demonstration of eggs Demonstration
on of eggs on of egg in on of egg in on of eggs in on of egg in of egg in feces in feces; differential of eggs in
in feces; feces feces feces; feces ; identification needed sputum or in
differential differential differential feces
Lab.
diagnosis diagnosis diagnosis w/
diagnosis
between between eggs of
spurius and spurius and Fasciola
true true hepatica
infection infection
DIOECOUS FLUKES
- Referred to as Blood flukes
- Belonging to the Genus Schistosoma
- Gross morphology: 2 points of differentiation
• Different sexes
• Shape : elongated & narrower; compressed dorsoventrally
- Oral & ventral sucker : present in both female(longer and slender) and male (shorter and more robust)
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 40
Criteria Schistosoma japonicum Schistosoma mansoni Schistosoma haematobium
Common Oriental blood fluke Manson’s blood fluke Vesical blood fluke
name
Definitive host Man Man man
Snails Snails Snails
Intermediate
Oncomelania hupensis quadrasi From Genus Biophalaria and Genus From Genus
host
Australorbis Bulinus and Genus Planorbis
Preferred Superior mesenteric venules (veins that Inferior mesenteric venules (veins that Vesical plexus (venules that drain into
habitat in man drain in the small intestine) drain into the large intestine) the urinary venules)
Egg stage Non operculated mature Non operculated mature Non operculated mature
Smallest; ovoidal in shape; characterized Largest of the 3; eggs are elongated with Elongated with a rounded anterior, and
by rudimentary lateral knob pointed anterior, posterior end is the posterior is tapering into a terminal
rounded with a prominent lateral spine spine
Ova
Lateral knob ; 70-105 x 50-80 μm 140-180 x 45-70 μm 112-170 x 40- 70 μm
50-100 ova in uterus 1-4 ova in uterus 20-30 ova in uterus
Ovary Central Anterior half Posterior half
Tegument Smooth Coarsely tuberculated Slightly tuberculated
(male)
Testes 6-8 testes 8-9 testes in a row 4-5 testes
Clinical Intestinal schistosomiasis Intestinal schistosomiasis Urinary schistosomiasis
features Also referred to as “ Bilharziasis or Bilharz disease ”
Associated w/ skin penetration of the cercaria resulting into “ schistosome dermatitis”; characterized by reddish rash &
a. Early stage
pruritus referred to as “swimmer’s itch or water itch or clamp digger’s itch”
a. Characterized by toxic and allergic manifestation associated w/ the presence of parasite in the blood circulation;
manifested by fever, hepatomegaly coughing and lymphadenopathy collectively termed as “katayama disease or syndrome” ;
b. Acute stage commonly observed with Schistosoma japonicum ; rarely for S. haematobium and less for S. mansoni
b. Intestinal signs and symptoms include abdominal pain and diarrhea
c. Urinary signs and symptoms include dysuria and hematuria
c. Chronic Characterized by granuloma formation
stage (ectopic eggs are carried by Blood in other sites of the body)
Stool Microscopic examination of egg Stool Microscopic examination of egg Microscopic examination of egg with
with lateral knob, with lateral spine, terminal spine,
o Specimen: urine; SF, occasionally feces,
Laboratory
antigens antigens more often in vesical or rectal biopsies
diagnosis
antigens
Geographic Far east : Japan (eradicated);China, Africa and South Africa Africa and M iddle East
distribution Philippines
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 41
Laboratory diagnosis:
1. Demonstration of parasite (ova/egg)
2. Serologic tests:
a. ELISA : uses monoclonal antibodies; demonstrate two glycoprotein antigens assicuated with the gut
of adult schistosomes (circulating, anodic “CAA” and cathodic “CCA” antigens); sensitive and specific
b. Skin tests : group specific
i. Intradermall allergic test (Fairley’s test)
- Uses antigen from infected snails, from cercaria, eggs and adult schistosomes
c. Other serologic tests: not very useful ; complete fixation, bentonite flocculation, indirect
hemagglutination, immunofluorescence, gel diffusion
d. Special tests : 2 circumoval precipitation
- Globular or segmented precipitation around schistosome eggs incubated in positive sera
- “Cercarien-hullen” reaction : development of pericercarial mmbranes around cercaria
incubated in positive sera
3. Ultrasonography
4. Demonstration of biopsy samples
- Rectal valve
- Urinary bladdler
5. Viability tests : eggs
a. Flame cell activity
- In each egg 4 flame cells (part excretory system;one on each corner) examined under HPO
- (+) motile flame cell - viable
- (–) not motile - nonviable
b. Miracidial hatching test
- Specimen is mixed w/ distilled water, placed in a flask w/ a side arm, covered w/ a foil or
dark paper except for the side arm
- Allowed to stand in a presence of a desk lamp
(+) eggs will hatch releasing miracidia – viable
(–) no hatching – nonviable
- Miracidia: prototrophic ; swims toward the light (side arm of the flask)
Compiled by: Frances Lictag Edited By: Saintclaus_eso 2114175 PARASITOLOGY NOTES 2015 Page 42